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Time course of appearance and disappearance of human mast cell tryptase in the circulation after anaphylaxis.
Open accessAbstract
Tryptase, a neutral protease of human mast cells, is a potentially important indicator of mast cell involvement in various clinical conditions. The current study examined the time course of appearance and disappearance of tryptase in the circulation after an anaphylactic event and the stability of both endogenous and exogenous tryptase in terms of freeze-thawing and temperature. The peak level of tryptase after an experimentally induced systemic anaphylactic reaction occurred 1-2 h after the initiating bee sting in each of three subjects, in contrast to histamine levels which peaked at 5-10 min. In some cases elevated levels of tryptase may not be detected during the initial 15-30 min. Tryptase levels then declined under apparent first order kinetics with a t1/2 of approximately 2h. Similar disappearance kinetics were observed for two subjects presenting in the emergency room with immediate type reactions, one with severe asthma after indomethacin ingestion, the other with systemic anaphylaxis after a bee sting. Histamine levels declined rapidly and were back to baseline by 15-60 min. Measured levels of tryptase in serum or plasma were not diminished by up to four freeze-thaw cycles. Incubation of serum samples taken from subjects with elevated levels of tryptase at 22 and 37 degrees C indicated that greater than 50% of endogenous tryptase was still detected after 4 d. Purified tryptase added to serum or plasma and incubated as above was less stable: approximately 50% of exogenous tryptase in serum and approximately 15% in plasma was detected after 2d of incubation. Therefore, optimally samples should be stored frozen, but even those stored at room temperature for up to 4 d should be satisfactory. The best time to obtain samples for tryptase determinations is 1-2 h after the precipitating event, but depending on the magnitude of the initial response elevated levels of tryptase may be present in the circulation for several hours.
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“the most specific and reliable marker of systemic MC activation is an acute and substantial event-related (transient) increase in the serum tryptase level over the individual’s baseline value.”
From Why the 20% + 2 Tryptase Formula Is a Diagnostic Gold Standard for Severe Systemic Mast Cell Activation and Mast Cell Activation Syndrome (2019) · cites this paper as [16]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“although it was clear that tryptase is the biomarker of choice to define anaphylaxis and thus MCAS based on previous literature data and experience in specialized centers [12–18], a diagnostic threshold was missing.”
From Why the 20% + 2 Tryptase Formula Is a Diagnostic Gold Standard for Severe Systemic Mast Cell Activation and Mast Cell Activation Syndrome (2019) · cites this paper as [16]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“tryptase has been repeatedly described as the most specific and reliable biomarker of severe systemic MC activation in daily practice [12–18].”
From Why the 20% + 2 Tryptase Formula Is a Diagnostic Gold Standard for Severe Systemic Mast Cell Activation and Mast Cell Activation Syndrome (2019) · cites this paper as [16]
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“In the work-up of anaphylaxis, BST levels raise significantly after the episode due to the considerable release by MC and is expected to turn to the baseline value at least after 24 h (28, 29).”
From Defining “Normal” basal serum tryptase levels: a context-dependent approach to improve diagnostics in systemic mastocytosis (2025) · cites this paper as [29]
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“during and shortly after a severe anaphylactic event where MC release large amounts of tryptase, the serum tryptase level increases substantially over the individual’s baseline (Fig. 1) [12–17].”
From Why the 20% + 2 Tryptase Formula Is a Diagnostic Gold Standard for Severe Systemic Mast Cell Activation and Mast Cell Activation Syndrome (2019) · cites this paper as [16]
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“Recently Schwartz and collaborators have isolated and characterized a tryptase from human mast cells (8).”
BackgroundUn dosage de tryptase sérique dans des situations d’urgence est-il utile ?
Petit, N., Rothmann, C., Frémont, S., Bollaert, P., Kanny, G., & Moneret‐Vautrin, D. A. (2003) · Revue Française d Allergologie et d Immunologie Clinique · doi:10.1016/s0335-7457(03)00113-8 · Cited by 1
Multiple Blood Donations and Iron Deficiency in Patients With Restless Legs Syndrome
Moore, S. B., & Winters, J. L. (2003) · Mayo Clinic Proceedings · doi:10.4065/78.5.654 · Cited by 2
Calvani, M., Cardinale, F., Martelli, A. M., Muraro, M. A., Pucci, N., & Savino, F. D. (2007) · Springer eBooks · doi:10.1007/978-88-470-0621-8_10 · Cited by 2
Ownby, D. R. (1995) · Allergy · doi:10.1111/j.1398-9995.1995.tb02718.x · Cited by 2
“Peak elevation of serum tryptase is found 45 to 60 minutes after the onset of the reaction and serum concentrations may remain elevated for hours (21).”
BackgroundIn vitro methods to assess allergy
Akar-Ghibril, N., & Chang, C. C.-C. (2022) · Elsevier eBooks · doi:10.1016/b978-0-323-95061-9.00011-4 · Cited by 1
Challenges in testing for platelet‐related adverse events
Kjeldsen‐Kragh, J. (2011) · ISBT Science Series · doi:10.1111/j.1751-2824.2011.01455.x · Cited by 1
Refractory anemia in a patient with allergy to intravenous iron drugs
Fishbane, S. N. (2006) · Kidney International · doi:10.1038/sj.ki.5001536 · Cited by 1
Raison‐Peyron, N., Meunier, L., Perney, P., Blanc, F., & Meynadier, J. (1998) · Revue Française d Allergologie et d Immunologie Clinique · doi:10.1016/s0335-7457(98)80182-2 · Cited by 1
76-Year-Old Woman With Pruritis and Lip Swelling
Sartori‐Valinotti, J. C., Kloesel, B., & Park, M. A. (2013) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2012.11.016 · Cited by 1
GUIDELINE FOR DIAGNOSTIC TESTING IN ALLERGY - UPDATE 2014
Hawarden, D. A. (2014) · Cited by 1
Ollert, M. W., Jakob, T., & Renz, H. E. (2016) · Springer eBooks · doi:10.1007/978-3-642-37203-2_51 · Cited by 1
Uncommon cause of complicated myocardial infarction with normal coronary arteries in a Saudi patient
Abuosa, A. M., Alrahimi, J. S., Nasir, M., Bilal, A., AlQabbani, A., & Neyaz, A. (2018) · Journal of the Saudi Heart Association · doi:10.1016/j.jsha.2018.06.005 · Cited by 1
“It is known that serum tryptase returns to normal levels within 6–24 hours [7].”
BackgroundMonitoring the Allergic Inflammation
Venge, P. (2009) · Springer eBooks · doi:10.1007/978-4-431-98349-1_25 · Cited by 1
Ebo, D. G., Vlaeminck, N., van der Poorten, M. M., Elst, J., Toscano, A., Gasse, A. L. V., Hagendorens, M. M., Aerts, S., Adriaensens, I., Saldien, V., et al. (2023) · World Allergy Organization Journal · doi:10.1016/j.waojou.2023.100759 · Cited by 3
Advancements in understanding anaphylaxis: From triggers to therapeutic strategies
Li, L., Chen, H., & Rongfei, Z. (2025) · Allergy medicine. · doi:10.1016/j.allmed.2025.100034 · Cited by 2
Shakanti, Y., Irhouma, A., & Hassan, A. A. (2025) · Cureus · doi:10.7759/cureus.89641 · Cited by 1
“Serum tryptase levels rose from 3.1 µg/L at baseline to 13.4 µg/L three hours post exposure, confirming mast cell activation and supporting a diagnosis of anaphylaxis [11].”
InfluentialBucher, C., Uebelhart, D., Wüthrich, B., Swanenburg, J., & Goerres, G. W. (2010) · The Open Allergy Journal · doi:10.2174/1874838401003010007 · Cited by 1
Hitosugi, M., & Matsumoto, A. (2015) · Journal of General Practice · doi:10.4172/2329-9126.1000239 · Cited by 1
“Tryptase, a mediator stored in the secretory granules of mast cells, is a useful indicator of the anaphylactic/anaphylactoid reaction owing to its relatively long halflife in the blood [4,5].”
BackgroundAllergic Transfusion Reactions
Madden, K. M., & Raval, J. S. (2019) · Elsevier eBooks · doi:10.1016/b978-0-323-67509-3.00004-4 · Cited by 1
In The Light of the Guidelines: Anaphylaxis
Evcen, R., & Arslan, Ş. (2021) · Selçuk Tıp Dergisi · doi:10.30733/std.2021.01502 · Cited by 1
“The best time interval for taking the serum triptase measurement is 15 mins after the onset of anaphylactic symptoms and at 3 hours at the latest (21).”
BackgroundFogg, M. I., & Pawlowski, N. A. (2003) · Pediatric Case Reviews · doi:10.1097/01.pca.0000063463.02713.c1 · Cited by 1
Schwartz, L. B. (1998) · Elsevier eBooks · doi:10.1016/b978-012473340-4/50020-5 · Cited by 1
Self-citationThiolier, S., Ughetto, Martin, C., LAMAISON, D., Outtas, O., Evrard, B., & Tridon, A. (2008) · Revue Française d Allergologie et d Immunologie Clinique · doi:10.1016/j.allerg.2008.03.006 · Cited by 1
Nilsson, K., Dunder, U., Nilsson, K., Schwartz, L. B., & Nilsson, G. P. (1996) · Scandinavian Journal of Immunology · doi:10.1046/j.1365-3083.1996.d01-311.x · Cited by 1
Self-citationHuman Mast Cells, Basophils and Their Mediators
Casolaro, V., Stellato, C., de Crescenzo, G., Triggiani, M., & Marone, G. (1992) · Springer eBooks · doi:10.1007/978-1-4615-3446-4_5 · Cited by 1
Metadata
- Authors
- Schwartz, L. B., Yunginger, J. W., Miller, J., Bokhari, R., & Dull, D.
- Affiliations
- Virginia Commonwealth University Medical Center (US)
- Mayo Clinic (US)
- Venue
- Journal of Clinical Investigation
- Published
- 1989-05-01
- Volume
- 83
- Issue
- 5
- Pages
- 1551-1555
- ISSN
- 0021-9738 (ISSN-L)
- PMC
- PMC303860
- OpenAlex
- W2024275029
- Cited by
- 456
- References
- 18
- Citations by year
- 2026: 4 · 2025: 13 · 2024: 6 · 2023: 9 · 2022: 6 · 2021: 14 · 2020: 6 · 2019: 16 · 2018: 8 · 2017: 10 · 2016: 11 · 2015: 12 · 2014: 20 · 2013: 9 · 2012: 4
- FWCI
- 6.41
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Clinical Investigation (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Allergy and Infectious Diseases (AI20487, AI-72621)
- Topics
- Life Sciences › Immunology and Microbiology › Immunology › Mast cells and histamine
- Health Sciences › Medicine › Immunology and Allergy › Food Allergy and Anaphylaxis Research
- Health Sciences › Medicine › Pharmacology (medical) › Drug-Induced Adverse Reactions
- Keywords
- tryptase, mast cells, anaphylaxis, bee stings, histamine, freeze-thaw cycles, sample storage, immediate hypersensitivity, serum biomarkers
- MeSH terms
- Adult, Anaphylaxis, Body Temperature, Child, Preschool, Female, Freezing, Histamine Release, Humans, Kinetics, Mast Cells, Peptide Hydrolases, Temperature
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